目的 探讨以胃肠道症状为主诉抑郁焦虑患者和无胃肠道症状抑郁焦虑患者的特点及治疗.方法 将就诊于心理科,无胃肠道症状的抑郁焦虑者设为A组,以胃肠道症状为主诉,经消化内科确诊肠易激综合征(IBS),疗效不理想,转诊至心理科就诊者设为B组.两组患者当天评定汉密顿抑郁量表(HAMD17)、汉密顿焦虑量表(HAMA14)并经精神科副高以上医师认为同时符合ICD-10抑郁或者焦虑诊断.患者性别、年龄不限,使用帕罗西汀治疗,疗程为6周.治疗后第1、2、4、6周末复评HAMD17、HAMA14.总分减分≥50%为有效、≤49%为无效,总分得分≤7为治愈.结果 两组患者性别比例差异无统计学意义(P>0.05).B组年龄、病程均大于(长于)A组(P<0.01).两组患者抑郁、焦虑症状的严重程度、使用帕罗西汀剂量差异无统计学意义(P>0.05).治疗后第1周末,A组HAMD、HAMA降分快于B组(P<0.01),而且这种趋势持续至疗程结束.组内比较,A组治疗后第1周末HAMD17、HAMA14得分下降明显(P<0.01).而B组治疗后第1周末HAMD、HAMA得分下降不明显(P>0.05),在治疗后第2周末HAMD、HAMA得分下降明显(P<0.01).A组治愈21例,B组治愈15例,A组治愈率高于B组(P<0.05).结论 以胃肠道症状为主诉抑郁焦虑患者病期长,年龄偏大且疗效差.%Objective To investigate the characteristics and treatment of depression and anxiety patients with gastrointestinal symptoms as the main complaint and depression and anxiety patients without gastrointestinal symptoms.Methods The depression and anxiety patients without gastrointestinal symptoms who received in psychology department were group A and the depression and anxiety patients with gastrointestinal symptoms as the chief complaint who confirmed by gastroenterology as Irritable Bowel Syndrome(IBS),and the effect was not ideal and referral to the psychiatric treatment in group B. The two groups of patients were assessed by HAMD17 and HAMA14 on the same day and the deputy high above psychiatric physicians agreed that they had met the ICD-10 depression or anxiety diagnosis at the same time. Patients' gender and age were not limited, and were treated with paroxetine,and whole study was 6 weeks. At the end of the first,second,fourth and sixth week after treatment,HAMD17, HAMA14 were reassessed. Total score decreased by more than 50% was effective,no more than 49% was invalid,total score of no higher than 7 was cured.Results There was no significant difference between the two groups(P>0.05).The age and disease duration of group B were older(longer) than those in group A(P<0.01). There was no significant difference in the severity of depression and anxiety and the using of paroxetine dosage between the two groups(P>0.05). At the end of the first week after treatment,HAMD and HAMA in group A were dropping faster than those in group B(P<0.01),and this trend continued until the end of the study. In group A,the scores of HAMD17 and HAMA14 decreased significantly at the end of the first week after treatment(P<0.01). In group B,the scores of HAMD and HAMA were not significantly decreased at the end of the first week after treatment(P>0.05),but the scores of HAMD and HAMA decreases significantly at the end of the second week after treatment (P<0.01). 21 cases were cured in group A and 15 cases were cured in group B,and the cure rate in group A was higher than that in group B(P<0.05). Conclusion The depression and anxiety patients with gastrointestinal symptoms are longer in disease duration,older in age and poorer in efficacy.
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